Beginner Medical English

A Reference Handbook for Mongolian Students and Healthcare Professionals (DOWNLOAD)

Medical Terminology

ONLINE LESSONS for Healthcare Professionals in Mongolia

Human Anatomy and Physiology

by Dr. Bruce Forciea, 2012 (DOWNLOAD)

Cells: Molecules and Mechanisms

University Cell and Molecular Biology textbook (DOWNLOAD)

Monday, November 18, 2013

People power: Mongolia’s battle against tuberculosis

Originally posted on "" on 15 October 2013
by Cameron Wright

Volunteers take anti-TB medications to around 400 patients each month. Image from

Chinggis Khaan (or as he is known in many countries, Genghis Khan) is Mongolia’s national hero. The famous 12th and 13th century leader used considerable military and political savvy to build one of the largest empires in history. But while he was building an empire, another invader silently spread from person to person.

This invader, Mycobacterium tuberculosis, favours stealth over force. The disease that it causes, tuberculosis (TB), has endured from ancient times into the 21st century.

It is estimated that one-third of the world’s population is infected with Mycobacterium tuberculosis and around 5% to 10% of these will develop active TB in their lifetime.

Even with effective antibiotics, TB is still a major global health problem, though it is rarely seen in developed countries such as Australia. TB disproportionately affects the world’s vulnerable, with over 95% of active cases and deaths caused by TB occurring in developing countries. Mongolia has a high burden of TB relative to its population.

Chinggis Khaan’s status was re-affirmed in July when the capital,
Ulaanbaatar’s main square was renamed Chinggis Square. Image from

The World Health Organization’s (WHO) most recent Global TB Report estimated that in 2011 there were 8.7 million new TB cases and each day, the disease claims around 4,000 lives. For a disease that is treatable and curable, these statistics are alarming.

This year I’m working with the Mongolian Anti-Tuberculosis Association (MATA). Founded in 1993, MATA is a “home-grown” example of community health workers having a positive impact on TB control. Through a nation-wide network of 300 health volunteers, this organisation coordinates the provision of anti-TB medications, mainly targeting people unable to visit health clinics regularly.

The WHO recommends that anti-TB treatment is given through a scheme known as DOTS (directly observed treatment, short-course), as adherence to medicines over the typical six-month treatment course can be sporadic unless patients are adequately supported. Under DOTS, each dose of anti-TB medication is supervised and signed off by a health worker or volunteer.

MATA volunteers take anti-TB medications to around 400 patients each month through home visits, with volunteers serving patients living in their local city sub-district or town. An additional 280 patients attend contracted cafeterias for a free meal along with their anti-tuberculosis medications.

Volunteers are trained in the basics of TB and can become an important primary source of information, support, early identification of treatment issues and also a vector for encouraging contacts of patients to attend clinics for TB screening.

L-R: S Munkhjargal (MATA volunteer), D Enkhtsetseg (MATA Volunteer Supervisor), T Bayanjargal (TB clinic nurse in Ulaanbaatar) and Y Byambaa (MATA volunteer). These women are part of the team working towards eradicating tuberculosis in Mongolia. Photo Cameron Wright.

For their work, volunteers are provided with a small monthly stipend, the Mongolian equivalent of around 30 Australian dollars. They are supervised by MATA staff and work with tuberculosis clinic doctors and nurses who take responsibility for treatment decisions.

The results of this program so far are impressive. This is best demonstrated by looking at treatment outcomes for a specific group of new patients who have returned positive tests, of which approximately 30% of the national total are involved in MATA’s program.

Of 621 patients from this group enrolled with MATA in 2011, 600 (about 97%) successfully finished treatment and almost all of these were cured of the disease. This is compared to an overall treatment success rate for this group of around 88%, reported by the National TB Program.

I spoke to some volunteers based in Bayanzurkh district, an area of Ulaanbaatar (also known as Ulan Bator) with one of the highest prevalence of TB in Mongolia. I asked one volunteer why she was involved in MATA’s program and she replied, through translation,

There is a great feeling of accomplishment for me and the patient when someone finishes their treatment and is cured. Meeting these volunteers – and witnessing their dedication – makes me think that with time, the TB situation can improve.

Managing a community-based treatment program on a national scale inevitably comes with a set of challenges. The last two decades have seen widespread internal migration, especially during winter, from the countryside into Ulaanbaatar.

Multiple factors have caused this including the transition to a market-based economy following the fall of the Soviet Union, with people increasingly seeking opportunities in the city.

Urban slums are ideal breeding grounds for TB. Image from

Adding to this, a series of dzuds (particularly harsh winters, commonly associated with a high livestock fatality rate) over recent years has made the continuation of a traditional herder lifestyle untenable for many.

This has led to an expansion of the “ger districts”, urban slums with a multitude of social problems and high rates of TB. The close living quarters during winter, when temperatures can plummet below -40°C, create ideal conditions for TB transmission.

Keeping track of TB patients who have started on treatment is one of the main problems our volunteers face in providing treatment, with many people returning to the countryside during summer. Other issues include reaching patients living in very remote places or those frequently moving around.

Lack of awareness and misconceptions can also be problematic when trying to encourage patients to complete their treatment. A 2012 national survey showed that most people know that TB is curable (84%) and is an air-borne infection (74%).

But many of those surveyed did not know treatment is provided free of charge (49%) or the signs and symptoms of TB (43%) which typically include a chronic cough, night sweats, unexplained weight loss, fever and/or tiredness.

Educating the public about TB can greatly improve case finding and treatment efforts and there is still progress to be made in this area. Providing high-quality training to volunteers is another important aspect of the program and this is complex to manage on a national scale.

Just over half of Mongolians surveyed knew the signs and symptoms of TB. Image from

Earlier this year I had the chance to participate in the external review of the National Stop TB Strategy 2010-2015, conducted with the support of the WHO. This provided an opportunity for reflection; to praise the many positive achievements of the National TB program and to identify areas where improvements could be made.

My main observation working in the TB area so far is that teamwork is central to reducing the global TB burden. From MATA, to the National TB Program and more broadly the WHO, the Stop TB Partnership and the International Union Against Tuberculosis and Lung Disease (among others), there is a huge network of people working towards a common goal.

Through utilising these partnerships, praising the good and improving the not so good, we can work towards making TB join smallpox as a disease of the past, in spite of the huge challenges that lie between this goal and the present situation.

Definition List:
  • savvy: practical knowledge or understanding of something
  • stealth: the fact of doing something in a quiet or secret way
  • to endure: to continue to exist for a long time
  • adherence: the fact of behaving according to a particular rule, etc, or of following a particular set of beliefs, or a fixed way of doing something
  • sporadic: happening only occasionally or at intervals that are not regular
  • vector: something (like an insect) that carries diseases between larger animals and humans
  • to enroll: to arrange for yourself or for somebody else to officially join a course, school, etc
  • prevalence: that exists or is very common at a particular time or in a particular place
  • untenable: that cannot be defended against attack or criticism
  • to utilize: to use something, especially for a practical purpose
Pronunciation MP3:
= savvy
= stealth
= endure
= adherence
= sporadic
= vector
= enroll
= prevalence
= untenable
= utilize

Monday, November 11, 2013

The Dangers of Acetaminophen

Originally posted on on Nov 3, 2013
by Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM
When it comes to proven, over-the-counter solutions for easing pain and controlling a fever, acetaminophen (also called paracetamol, and best known by the brand name, Tylenol) has long been the preferred recommendation for many. It is actually the most widely used product of its kind, and with good reason. When compared to other non-prescription pain relievers and fever reducers, such as aspirin or ibuprofen, acetaminophen is considered to be much more safe — especially for young children, people with weak or compromised liver function, or blood-clotting concerns.

The Dangers of Acetaminophen

But, not so fast. Despite being a better choice than some of the alternatives, acetaminophen doesn’t exactly get a free pass. To the contrary, severe health problems such as liver damage and death have been reported, even after “mild” overdose.
  • A 10-fold increase in overdose has been reported in children given injectable paracetamol.
  • In one reported case, an overdose of acetaminophen resulted in death with blistering of the skin and rhabdomyolysis (a breakdown of the muscle fibers) with blood clotting and reduced blood flow to the heart.
  • Overdose in children occurs more quickly with more severe problems than adults.
  • Renal failure has been observed in persons suffering from acetaminophen overdose.
  • One study found that patients taking acetaminophen for dental pain were at a higher risk of suffering accidental poisoning.
  • In 2011, the British Medical Journal reported heavy alcohol consumption, fasting, malnourishment, and the taking of enzyme inducing drugs increased the likelihood of liver damage from acetaminophen use. 
Even the US Department of Health and Human Services, a division of the FDA, warns of dangers of taking Acetaminophen.

Simple Mistakes Can Lead to Complicated Problems

You may be thinking, “Good grief! I thought this stuff was safe!” Well, you’re not alone. There’s a common misconception that, because it’s sold without a prescription, it is also safe to take acetaminophen very regularly to alleviate any and all minor aches and pains. Additionally, the over-the-counter classification has lead some individuals to casually disregard dosage instructions and consume more than directed. If two is great, then four must be better, right? Wrong. Those errors are why hospital emergency rooms deal with more acetaminophen overdoses on an annual basis than they do opiate overdoses.

A good example would be taking acetaminophen to cope with a slight hangover. Not only is this use unnecessary (you likely need hydration, not acetaminophen), but it can further stress an already stressed liver. In fact, this exact scenario accounts for a large percentage of easily avoidable overdoses.

Watch for Hidden Acetaminophen

Another mistake many people make is not reading the labels on the back of over-the-counter products before using them. Use of acetaminophen is prolific among drug manufacturers, and it’s not uncommon to find it included in everything from sleep aids to cold and allergy medications. It’s fairly common for those who are under the weather to take several products at once. These small doses can easily add up, and if you’re not careful, may lead to permanent liver damage.

In addition to keeping an eye out for hidden sources, and minimizing unnecessary use, using a high quality, all-natural liver supplement and performing a periodic comprehensive liver and gallbladder flush, is a great way to promote the health of your liver.

Definition List:
  • over-the-counter: that can be obtained without a prescription (= a written order from a doctor)
  • to ease: to become or to make something less unpleasant, painful, severe, etc.
  • to compromise: a solution to a problem in which two or more things cannot exist together as they are, in which each thing is reduced or changed slightly so that they can exist together
  • alternative: a thing that you can choose to do or have out of two or more possibilities
  • contrary: completely different in nature or direction
  • severe: extremely bad or serious
  • overdose: too much of a drug taken at one time
  • -fold: multiplied by; having the number of parts mentioned
  • fasting: to eat little or no food for a period of time, especially for religious or health reasons
  • malnourishment: in bad health because of a lack of food or a lack of the right type of food
  • misconception: a belief or an idea that is not based on correct information, or that is not understood by people
  • to disregard: to not consider something; to treat something as unimportant
  • opiate: a drug derived from opium. Opiates are used in medicine to reduce severe pain.
  • slight: very small in degree
  • hangover: the headache and sick feeling that you have the day after drinking too much alcohol
  • hydration: to make something absorb water
  • scenario: a description of how things might happen in the future
  • prolific: existing in large numbers
  • "under the weather": you feel slightly ill/sick and not as well as usual
  • flush: to get rid of something with a sudden flow of water
Pronunciation MP3:
= acetaminophen
= ease
= compromise
= alternative
= severe
= overdose
= fold
= malnourished
= misconception
= disregard
= opiate
= slight
= hangover
= hydration
= scenario
= prolific

Monday, November 4, 2013


iBiology is a brand-new site where you can find all of the iBioSeminars and iBioMagazine talks in one place, along with a new section called iBioEducation where you will find…

Nico StuurmaniBiology Microscopy Courses: Microscopy Courses featuring
over 65 lectures and lab demonstrations about the theory and practice of light microscopy.

New Lecture series: New series with the flipped-classroom in mind. We asked speakers to create ~30 minute lectures that explain a topic for high school/undergraduate introductory biology students including:

New Lectures
  • Cell Biology [Cytoskeleton]: Molecular Motors (Lasker)
  • Cell Biology [Organelles]: Mitochondria, Mysterious Membranes
  • Human Health [Organelles] The Immune System
  • Microbiology [Bacteria Communities] Tiny Conspiracies
  • Molecular Biology [DNA Repair and Replication]: DNA Replication
  • Neuroscience [Circuits and Behavior]: One Second in Your Brain
Lectures from iBioSeminars
  • Biochemistry [Carbohydrates]: Glycans
  • Cell Biology [Cytoskeleton]: Actin Polymerization, Cell Motility, Molecular Motors, Comet Tail Formation
  • Cell Biology [Cell Cycle]: Cell Cycle Overview, Cell Cycle Control, Separating Duplicated Chromosomes, Cyclins and CDKs
  • Cell Biology [Organelles] Experiments in Cellular Organization
  • Development [Regeneration]: Stem Cell Overview, History of Regeneration, Adult Stem Cells
  • Ecology [Ecology]: Microbes Are Ancient, Ubiquity of Microorganisms
  • Human Health [Pathogens]: Prion Disease
  • Microbiology [Viruses]: Influenza Virus Infection
  • Molecular Biology [Transcription]: Introduction to Transcription
  • Molecular Biology [RNA Regulation]: Splicing Overview, Splicing Mechanism, Splicing Experiment
  • Neuroscience [Circuits and Behavior]: Genes and Behavior, Odor Experiment, External Signal Response, Circadian Clock
  • Neuroscience [Molecular Neuroscience]: Neural Stem Cells
BiochemistryiBioEducation Short Clips
Want to watch a few short videos when you have a break in the day? In iBioEducation's Exploring Biology section, you can find over 350 short clips organized by topic.

  • 1
Cell Biology
Cell Biology
Human Health
Human Health
Molecular Biology
Molecular Biology
Plant Biology
Plant Biology

iBiology’s mission is to convey, in the form of open-access free videos, the excitement of modern biology and the process by which scientific discoveries are made. Our aim is to let you meet the leading scientists in biology, so that you can find out how they think about scientific questions and conduct their research, and can get a sense of their personalities, opinions, and perspectives. We also seek to support educators who want to incorporate materials that illustrate the process and practice of science into their curriculum. This project is made possible by the good will of many biologists who are committed to making their work broadly accessible and to conveying the excitement of biology to a worldwide audience. (formerly and was developed to bring the best biology to people throughout the world for free. Started in 2006 by University of California – San Francisco and Howard Hughes Medical Institute investigator, Professor Ron Vale, iBiology has grown to include over 300 seminars and short talks by the world’s leading scientists. Our collection includes talks by many Nobel Laureates and members of the United States National Academy of Sciences. In 2013, we released our first full-length course in Light Microscopy and expanded the educational resources we offer. iBiology is funded by the National Science Foundation, the National Institute of General Medical Sciences, and the Howard Hughes Medical Institute, and supported by the American Society for Cell Biology and the University of California, San Francisco.

Monday, October 28, 2013

In Mongolia, centre helps children with disabilities learn new skills

Originally posted on on May 28, 2013
By Sabine Dolan

UNICEF correspondent Sabine Dolan reports on a mother in Mongolia who is taking care of a daughter with learning disabilities.

Like all children, those with disabilities have many abilities, but are often excluded from society by discrimination and lack of support, leaving them among the most invisible and vulnerable children in the world.

UNICEF launches its flagship report The State of the World’s Children 2013: Children with Disabilities on 30 May 2013. The report brings global attention to the urgent needs of a largely invisible population.

In northern Mongolia, a centre supporting children with disabilities has proven a lifeline for 13-year-old Uyanga.

Tsagaannuur, Khuvsgul province, Mongolia, 28 May 2013 – Tumenjargal is a kindergarten teacher in northern Mongolia. She’s also a wife and mother of four. The family live in the small village of Tsagaannuur, about an hour from the Russian border.

Tumenjargal’s 13-year-old daughter Uyanga enjoys the same things as a lot of girls her age. “She really loves music and dancing,” Tumenjargal tells us. “She could watch television for hours, listening to music, especially traditional music, and watching how people dance.”

Two days after she was born, Uyanga was diagnosed with brain damage, which left her with permanent learning disabilities. Uyanga has difficulty speaking, and her vision is impaired. She learned to walk when she was 3 years old. Her parents tell us she can usually walk alone in a familiar environment. Otherwise, she is afraid.

Challenges for Uyanga

In Uyanga’s village, there are few options for children with disabilities. Uyanga attended kindergarten from the age of 4 until she was 9. She then went to her brother’s school, but was soon faced with stigma and discrimination.

Uyanga, 13, (left) with her mother, Tumenjargal, outside their home in Tsagaannuur. Two days after she was born, Uyanga was diagnosed with brain damage, which has left her with permanent learning disabilities. © UNICEF Mongolia/2012/Dolan

“When she was 9, she started attending school with her brother, but children made fun of her,” Tumenjargal tells us. “It was hard for her brother, too, so she stopped going. It was difficult. There were some challenges.”

Children with disabilities are less likely to receive an education. They’re also less likely to engage with peers or have an opportunity to participate in their community. They are often neglected and isolated.

Inclusive education

Today, Uyanga attends a centre that helps children with disabilities learn new skills in a supportive and inclusive environment. UNICEF supports this centre, which has become a lifeline for Uyanga – who now enjoys learning and has made friends. UNICEF has also trained the teachers here to promote child participation and inclusive education. Thanks to this inclusive model, 40 children with disabilities are now enrolled in the centre as well as in the main school.

“She doesn’t yet know how to write, but she is exercising how to hold her pen,” Tumenjargal explains to us. “Also, she practises how to pronounce sounds and consonants. After school, she comes home and she tries to practise in front of the mirror.”

“Please help and try to understand”

Children with disabilities face many barriers; they encounter social exclusion, as do their families. Yet, in a supportive community, families can help foster a more inclusive and enriching environment.

“My message to parents of children with disabilities and people all over the world is this: Please help and try to understand children with disabilities,” Tumenjargal says.

UNICEF wants to raise awareness about the rights of all children. We want to support more centres for children like Uyanga so they can enjoy the same opportunities as others.

Definition List:
  • disability: a physical or mental condition that means you cannot use a part of your body completely or easily, or that you cannot learn easily
  • to exclude: to prevent somebody/something from entering a place or taking part in something
  • discrimination: treating somebody or a particular group in society less fairly than others
  • invisible: that cannot be seen
  • vulnerable: weak and easily hurt physically or emotionally
  • flagship: the most important product, service, building, etc. that an organization owns or produces
  • lifeline: something that is very important for somebody and that they depend on
  • to diagnose: to say exactly what an illness or the cause of a problem is
  • permanent: lasting for a long time or for all time in the future; existing all the time
  • impaired: damaged or not functioning normally
  • options: things that you can choose to have or do; the freedom to choose what you do
  • stigma: feelings of disapproval that people have about particular illnesses or ways of behaving
  • to engage: to succeed in attracting and keeping somebody's attention and interest
  • inclusive: including a wide range of people, things, ideas, etc
  • barriers: a problem, rule or situation that prevents somebody from doing something, or that makes something impossible
  • to encounter: to meet somebody, or discover or experience something, especially somebody/something new, unusual or unexpected
  • exclusion: a person or thing that is not included in something
  • to foster: to encourage something to develop
  • enriching: to improve the quality of something, often by adding something to it
Pronunciation MP3:
= disability
= exclude
= invisible
= vulnerable
= flagship
= lifeline
= diagnose
= permanent
= impaired
= option
= stigma
= engage
= inclusive
= barrier
= encounter
= exclusion
= foster
= enrich

Sunday, October 20, 2013

An Airway Created with a 3D Printer Saved This Baby’s Life

Originally posted on on May 23, 2013
By Matt Peckham

If you think 3D printing’s overhyped with all this talk of plastic guns and strange, spider-like houses, you clearly haven’t seen this: a tiny airway splint created using a 3D printer that saved a three-month-old’s life.

Doctors at C.S. Mott Children’s Hospital in Ann Arbor, Michigan paired their medical know-how with the latest 3D printing technology to generate a custom, synthetic bio-part that ultimately saved a child who’d lost the ability to breathe on his own.

Kaiba Gionfriddo, who lives with his parents in Youngstown, Ohio, had a rare birth defect known as tracheobronchomalacia: just one in 2,200 are born with it. In babies with the condition, the airway walls are so weak they frequently collapse when breathing or coughing, shutting down the airway. Parents (and doctors) often miss the condition until the child suddenly stops breathing, which is how, terrifyingly, Kaiba’s parents discovered while eating at a restaurant that their six-week-old baby had it.

“He turned blue and stopped breathing on us,” Kaiba’s mother April Gionfriddo told the Associated Press, at which point Kaiba’s father, Bryan, had to perform CPR to revive him. But the breathing problems continued, and Kaiba wound up on a breathing machine at Akron Children’s Hospital in Ohio; doctors there told Kaiba’s mother his chances of leaving the hospital alive were slim.

So when one of those Akron doctors, Marc Nelson, mentioned that researchers in Michigan were experimenting with artificial airway splints, Kaiba’s parents wasted no time getting in touch with the hospital and doctors Glenn Green, M.D. and Scott Hollister, Ph.D.

Writing of the situation on the Univeristy of Michigan’s health blog, Green notes that the timing was just right — he and Hollister had “been working on a type of device that would be perfect to help splint little Kaiba’s airway, keeping it clear for air to continually flow to the lungs.” According to Green:
Scott and I had been exploring creating implants using a type of biodegradable polyester called polycaprolactone for a while, but it had never been used in this way before. Because of the urgency of Kaiba’s life threatening condition, though, we were able to get emergency clearance from the Food and Drug Administration to create a tracheal splint for him, using the material.
Using high-res imagery from a CT scan of Kaiba’s afflicted airway, Green and Hollister were able to create a custom splint specifically tailored to fit Kaiba, then print it out on a 3D printer. The operation to install the tiny tube-like splint took place on Feb. 9, 2012, where Green says “[the] splint was sewn around Kaiba’s airway to expand the airway and give it a skeleton to help it grow properly and with greater strength,” adding that the splint is biodegradable — designed to be reabsorbed by Kaiba’s body over the course of three years.

“As soon as the splint was put in, the lungs started going up and down for the first time and we knew he was going to be OK,” wrote Green. Three weeks following the operation, Kaiba came off ventilator support and Green reports he hasn’t had breathing trouble since.

Just to underline the point here, that 3D printing technology, at least as far as medical research goes, is anything but overhyped, here’s Green again:
The image-based design and 3-D biomaterial printing process we used for Kaiba can be adapted to build and reconstruct a number of tissue structures. We’ve used the process to build and test patient-specific ear and nose structures. Scott has also used the method with other collaborators to rebuild bone structures in pre-clinical models.

Definition List:
  • overhype: to over advertise something a lot and exaggerate its good qualities too much
  • to pair: to put people or things into groups of two
  • to collapse: it falls in and becomes flat and empty
  • biodegradable: a substance or chemical that can be changed to a harmless natural state by the action of bacteria, and will therefore not damage the environment
  • high-res: = high resolution: showing a lot of clear sharp detail
  • afflicted: to affect somebody/something in an unpleasant or harmful way
  • to tailor: to make or adapt something for a particular purpose, a particular person, etc
  • to underline: to emphasize or show that something is important or true
  • to adapt: to change something in order to make it suitable for a new use or situation
Pronunciation MP3:
= pair
= collapse
= biodegradable
= tailor
= adapt

Tuesday, September 24, 2013

The online games teaching children about their cancer

Originally posted on the BBC on September 4th, 2013

A non-profit company called HopeLab has developed a series of free online games, known as Re-Mission 2, designed to help young people learn about their cancer.

The company spoke to those who had suffered from the disease for ideas about how to make the games more appealing.

HopeLab's research found players were more likely to stick to their treatments and view their chemotherapy treatment as a means of defence rather than an obligation.

Click's Sumi Das finds out more.


Re-Mission 2 games help kids and young adults with cancer take on the fight of their lives. Based on scientific research, the games provide cancer support by giving players a sense of power and control and encouraging treatment adherence.

Each game puts players inside the human body to fight cancer with an arsenal of weapons and super-powers, like chemotherapy, antibiotics and the body’s natural defenses. The game play parallels real-world strategies used to successfully destroy cancer and win.

All six Re-Mission 2 games can be played online. The Re-Mission 2: Nanobot’s Revenge mobile app is available for download for iOS and Android.


Re-Mission 2 is a project of HopeLab, a nonprofit that harnesses the power and appeal of technology to improve human health and well-being. The games are an evolution of the original Re-Mission, inspired by the vision of HopeLab founder Pam Omidyar to fight cancer with gameplay. All Re-Mission games are designed in collaboration with medical professionals, game developers and – most importantly – young cancer patients. We are deeply grateful for their input and expertise.

Definition List:

  • appealing: attractive or interesting
  • obligation: something which you must do because you have promised, because of a law, etc.
  • adherence: the fact of behaving according to a particular rule, etc, or of following a particular set of beliefs, or a fixed way of doing something
  • arsenal: a collection of weapons
  • strategies: a plans that are intended to achieve a particular purpose
  • collaboration: the act of working with another person or group of people to create or produce something
Pronunciation MP3:
= appealing
= obligation
= adherence
= arsenal
= strategy
= collaboration

Monday, September 16, 2013

The low cost technology saving premature babies' lives

Originally posted on the on August 26, 2013
By Shilpa Kannan, BBC News, Bangalore

Tiny lives: Premature babies have very little body fat and are unable to regulate body temperature
Every year more than 20 million babies are born prematurely or with low birth weight - and an estimated 450 of them die each hour.

Yet most of these deaths could be avoided by simply keeping them warm.

"A new-born baby wailing can generally be heard outside the room - even across the hallway. But not my baby. Mine can only whimper," says Jayalakshmi Devi.

She's standing outside the neo-natal intensive care unit (ICU) staring at the glass box where her baby son is kept.

Born too soon, her baby boy weighs less than 1.2 pounds (0.54kgs). Doctors have given him around a 40% chance of survival.

Having lost two babies already, Jayalakshmi didn't want to take a chance this time. After delivering her child in a rural healthcare centre three hours outside Bangalore, she brought the baby to the state run hospital in the city.

Women often give birth at home in rural areas and only bring them to hospitals when there is a critical need.

At Vanivilas hospital, the neo-natal ICU sees scores of premature babies. Most are born at home, in far off rural areas and are brought here in critical condition.

Row after row, the transparent boxes create warmth to hold the tiny, bare-bodied babies with only an oversized diaper around them. Some of the babies are small enough to fit into your palm.

Life-saving warmth

A baby's body temperature drops as soon as it is outside the controlled environment of the mother's womb. So just after labour, it's important to regulate the temperature.

But premature babies have very little body fat, so they are unable to do that.

The babies need incubators to help keep them alive - equipment which state-run hospitals like this one often cannot afford.

So, GE Healthcare created the Lullaby baby-warmer, to help to save lives in a country that has the highest rate of pre-term baby deaths in the world.

Small packages: Premature babies kept in the low-cost incubators in the neo-natal ICU in Vanivilas hospital in Bangalore

Low-cost innovation

It was developed in Bangalore and launched in 2009. The baby warmer costs $3,000 (£1,900) in India, 70% cheaper than traditional models.

The design includes pictorial warnings and colour coding, so that even illiterate rural healthcare workers can operate the machine.
Premature infants
  • Babies born before the 37th week of pregnancy are called pre-term and they have a lower survival rate.
  • Some 20 million babies are born prematurely or with a low birth weight every year.
  • More than one million of these babies die on their first day of life, and nearly three million die within the first month of life according to Save the Children.
  • Those babies who survive often suffer from serious ailments including diabetes and heart disease.
The Lullaby warmer also consumes less power than most incubators, which means cost savings for the healthcare centre.

"Where better to make a baby warmer than here - India produces a baby nearly every second," says GE Healthcare's Ravi Kaushik.

He believes India is an ideal innovation centre when it comes to products like this, because 70% of the population is rural and 30% is urban, and within this you all different stratas of society.

"So you can have very great world class hospitals that want and require world class medical equipment that America or Europe would require. But at the same time there is a population in rural space that would require same kind of medical attention," says Mr Kaushik.

"So when you design a product, you have to cater to the entire plethora of needs. That allows you to almost hit the entire world because India is a small representation of that."

Engineers at GE's technology centre are stripping down lifesaving, high tech medical devices of all their frills to understand how to create products that are affordable.

This project is now widely quoted as an example of "reverse innovation".

This is where large global companies design products in developing markets like India and then take the successful creation back to international markets to sell.

After success in the domestic market, GE now sells the warmer in more than 80 countries.

Bundled up

While this works for healthcare centres on a budget, it still needs continuous electricity to run.

The Embrace warmer is a low-cost sleeping bag-like product designed to be durable and re-usable

But go further down the population pyramid, and the problems get more complex.

Women in villages give birth at home and have little access to basic healthcare or electricity.

For them, keeping babies warm means wrapping them in layers of fabric and hot water bottles, or putting them under bare light bulbs.

Many of them don't survive.

But now a low cost baby bag is saving thousands of young lives. Called the Embrace, it emerged out of a class assignment at Stanford's Institute of Design in 2007.

Four graduate students - Jane Chen, Linus Liang, Naganand Murty, and Rahul Panicker - were challenged to come up with a low-cost incubator design that could help save premature babies born into poverty.

The team created a sleeping bag with a removable heating element.

Using high school physics, they used phase-change material (PCM), a waxy substance that, as it cools from melted liquid to solid, maintains the desired temperature of 37 degrees celsius (98.6 F) for up to six hours.

The end product looks like a quilted sleeping bag that is durable and portable. It requires only 30 minutes of electricity to warm up using a portable heater that comes with the product.

More importantly for mothers, it allows for increased contact with their child, unlike traditional incubators.

So it also encourages Kangaroo care, a technique practiced on newborn, especially pre-term infants, which promotes skin-to-skin contact to keep the baby warm and facilitate breastfeeding and bonding.

The infant warmer costs about $200 to make, is inexpensive to distribute, and is reusable.

All wrapped up: The Embrace warmers are donated to mothers in impoverished communities

Embrace is a non-profit venture. The product is not sold, but is donated to impoverished communities in need.

The invention is thought to have helped save the lives of more than 22,000 low birth-weight and premature infants.

Taking the programme forward, the organisation has developed a new version designed for at-home use by mothers. The model has been successfully prototyped and is currently undergoing clinical testing in India.

The organisation has also set up educational programmes to address the root causes of hypothermia.

"We provide intensive, side-by-side training to mothers, caretakers, and healthcare workers," says Alejandra Villalobos, director of development at Embrace.

"We develop long-term partnerships with local governments and non-profits in every community where we work.

"We believe that increased access to both technology and education is necessary to achieve our ultimate vision: that every woman and child has an equal chance for a healthy life."

To partner with EmbraceGlobal, click this link!

Definition List:
  • to wail: to make a long loud high cry because you are sad or in pain
  • to whimper: to make low, weak crying noises; to speak in this way
  • transparent: allowing you to see through it
  • to regulate: to control the speed, pressure, temperature, etc. in a machine or system
  • incubator: a piece of equipment in a hospital which new babies are placed in when they are weak or born too early, in order to help them survive
  • plethora: an amount that is greater than is needed or can be used
  • frills: things that are not necessary but are added to make something more attractive or interesting
  • venture: a business project or activity, especially one that involves taking risks
  • impoverished: very poor; without money
Pronunciation MP3s:
= wail
= whimper
= transparent
= regulate
= incubator
= plethora
= frill
= venture
= impoverished

Monday, September 9, 2013

When patients have 'music emergencies'

Originally posted on on August 23, 2013
By Elizabeth Landau, CNN

Brian Jantz, a music therapist at Boston Children's Hospital, plays with a patient, Yaneishka Trujillo. Jantz uses music to engage with children.

Brian Jantz marched down the hallway of the hospital with his guitar, accompanying a 4-year-old oncology patient with a maraca and a drum. He remembers they were singing their own creative version of "Itsy Bitsy Spider."

The girl had been anxious about an upcoming X-ray, he said, and resisted going to the procedure. Hospital staff paged Jantz to help. He kept the music going even on the elevator; the girl's parents, a nurse and a child-life specialist sang, too.

"I'm not completely sure that she realized when it was happening ... because before you knew it, we were back on the elevator, back in the room, and the music just continued straight through," Jantz said.

Jantz is one of two music therapists at Boston Children's Hospital, where the idea of using music to help patients as young as premature babies in the neonatal intensive care unit has taken off in the last decade. Jantz and his colleague have scheduled visits with patients in almost every unit but will come to a melodic rescue in urgent situations.

"We kind of joke around, 'It's like a music emergency,' but it really is," Jantz said. "It really can be like, 'This patient needs music therapy right now.' "

Music therapy formally began in the 20th century, after musicians went to play for World War I and World War II veterans at hospitals across the United States. Today, there are about 5,000 board-certified music therapists in the United States, according to the American Music Therapy Association. Over the last decade, the group's membership has expanded, particularly among students.

Music therapy has many uses, from treating individuals in private practice to elderly care settings.

"We're not huge, but are slow growing -- but a mighty -- group," said Barbara Else, senior adviser for policy and research at the American Music Therapy Association.

Why it works

There is scientific research to back up the idea that music has healing properties. A 2013 analysis by Daniel Levitin, a prominent psychologist who studies the neuroscience of music at McGill University in Montreal, and his colleagues highlighted a variety of evidence: for instance, one study showed music's anti-anxiety properties, another found music was associated with higher levels of immunoglobin A, an antibody linked to immunity.

The brain's reward center responds to music -- a brain structure called the striatum releases the chemical dopamine, associated with pleasure. Food and sex also have this effect. The dopamine rush could even be comparable to methamphetamines, Robert Zatorre, professor of neurology and neurosurgery at Montreal Neurological Institute, told CNN last year.

Beyond that, music presents a nonthreatening tool for interventions that is already attractive to patients, Jantz said.

"On the surface it works because, in some way, everyone relates to music," Jantz said. "Music really is universal."

Music therapists often work nonverbally, which is why the method is particularly effective for individuals with verbal expression difficulties, such as children with autism, Else said. The profession helps people at every age, from babies to Alzheimer's patients.

For individuals with autism in particular, music therapy has shown to be a positive reinforcement of appropriate behaviors and a motivator to reduce negative ones, according to the American Music Therapy Association. Music can also help with the development of language skills, and the identification and expression of emotions, which are characteristic challenges in autism. Some children with autism have superb musical abilities, and music therapy can help them focus on their strengths.

Alzheimer's patients, who have memory and thinking impairment, may still recognize songs of their youth or respond emotionally to music. Music can also be used in elderly care settings to calm or stimulate residents.

Music as a tool

Singing with someone when you feel anxious, or expressing emotions through songwriting, are more than just casual activities in music therapy. Therapists always have specific goals in mind, such as helping patients overcome a fear.

One fundamental of music therapy is called the "Iso principle," the idea that the therapist takes cues from the client when choosing what music to play. This can inform the improvised music that therapists and clients play together. If the client feels hyped up, the therapist and client might play vigorous drum beats together, but if the goal is to relax, they might begin energetically and then tone down.

Therapists are conscious of rhythm, tempo, texture and melody of the music as clients express themselves. In a hospital setting such as Jantz's, such components of music can also distract a patient who is in pain.

In Else's private practice, she has been helping a college student with an anxiety disorder called agoraphobia; the young woman, who was homeschooled, has been fearful of leaving her house.

The student writes song lyrics when she meets with Else, and also learns guitar from the therapist in the process. By discussing the lyrics and other elements of the music that the student generates through improvisation, the client and therapist uncover clues about what is fueling the woman's anxieties.

"We are using music as a mechanism. One, for motivation, but also as a mechanism so she can express herself and we can figure out what are some of these things that are driving her fears," Else said. "We've made a lot of progress."

Having worked through her issues with music, the young woman became more open to going out in public, Else said. She accompanied Else to a rehearsal for an opera, and then to an actual opera performance.

She has now started junior college and is doing well, Else said. The young woman still sees Else for follow-up maintenance.

"Part of that therapeutic process working with her ... was building a high level of trust," Else said. "Developing trust with someone so she could understand that the world isn't quite so scary out there, to get to the root cause."

Music as a lifesaver

Going through music therapy isn't always relaxing, fun or easy.

Cpl. Demi Bullock, 25, a former Marine, experienced post-traumatic stress disorder after her second deployment in Afghanistan. In summer 2011, music therapy was part of her treatment program.

At first, Bullock, who had played the guitar since she was 15, hated music therapy. Her therapist, Rebecca Vaudreuil, would organize activities such as a drum circle, lyric analysis, listening exercises or instrumental playing for service members in the program.

Impatience, and a desire to withdraw from emotion, quickly overtook Bullock. She refused to participate.

"I did not like playing music, having something make me feel that pain and that sadness, that can be completely overwhelming," she said.

Such resistance isn't unusual among returning military, Vaudreuil said. Some people can connect with music more than others, but in some cases it takes time and "soul-searching" for music to become a beneficial part of recovery.

Bullock rediscovered music therapy more than a year after her initial encounter with it. In January, Vaudreuil invited her to join the Semper Sound Band, a musical program through the nonprofit Resounding Joy Inc. that helps service members reintegrate into the community and promotes group cohesion. Vaudreuil was the band director at that time.

The invitation came at a particularly dark moment. Bullock was in the process of getting evicted and continued to struggle with PTSD and depression. She had also recently attempted suicide.

Bullock came to discover that jamming on a guitar, keyboard or drum set helped her cope with stress or intrusive thoughts. The band also provides a social support system and an outlet for self-expression.

"The songs that come out of it, and the process they go through, is so genuine," Vaudreuil said. "The songs are a direct reflection of their emotions, their trials, what they've been through, their experiences, and it's completely cathartic for them."

Bullock continues to play with the band, and works as an intern at Resounding Joy. Her job allows her to be on the facilitator side of music therapy, and connect with other veterans.

"If I hadn't gotten into it (music therapy), I'd literally be dead or still be homeless," Bullock said. "It literally did save my life."

Measuring calm

Other therapists are exploring technologies that allow them to see what effect music has on the human body, and use that information to guide clients. This is called biofeedback.

Eric B. Miller, a music therapist in Phoenixville, Pennsylvania, uses real-time data about patients' physiological responses to inform how he runs sessions. He recently discussed a biofeedback method at the Interdisciplinary Society for Quantitative Research in Music and Medicine conference in Athens, Georgia.

"The idea is that this information is informing me as a music therapist how I want to be playing my guitar, what tempo I'm going for," he said at the conference.

Conference attendees took turns listening to music while wearing a finger sensor. Through a computer program, a graph appeared on a projector screen showing relative heart rate, heart rate variance and skin conductivity in real time. The computer program then translated the readings from the sensor into tones, which could be heard overlayed with music.

Independent researcher Elijah Easton listened to another conference attendee (full disclosure: it was the author of this article) improvise on the piano. Easton said he found the activity relaxing; Miller noted that Easton's heart rate had decreased after the music stopped.

In a real session, Miller would create a physiological profile of a client by looking at his or her responses to sitting naturally, doing a cognitive task, relaxing and envisioning something emotional. After more relaxation, he would set up the biofeedback system of tones, and challenge the client to lower the tone, an indication of relaxation. Different tones can be assigned to different variables such as heart rate.

The point is helping clients learn the art of self-regulation, of adjusting their own bodies, Miller said.
"The music and the data are both co-therapists," Miller said.

Biofeedback-oriented music therapy can be used in a variety of conditions, including high blood pressure and seizures -- not necessarily instead of mainstream medicine, but in concert with it, Miller said.

"Western doctors may recommend it to complement existing treatment or as a trial in cases of adverse reaction to typical pharmacological remedies," he said.

In a more subtle way, Jantz also uses biofeedback with patients who are already hooked up to monitors at Boston Children's Hospital for medical reasons. When he plays music in the neonatal intensive care unit, he can see what impact strumming his guitar has by observing the heart rate graph.

Fun is part of it

Jantz sees music itself as having an intrinsic therapeutic value, in addition to the positive experience that a person can have with a music therapist. For children in particular, it can encourage them to learn a new skill; sometimes patients who stay at Boston Children's Hospital for longer periods get good at guitar.

Occasionally Jantz has to dress in a surgical gown and gloves, but for the most part the kids don't view what he does as a therapy -- they're just relieved that instead of poking and prodding, he's there to play music with them.

"There's nothing wrong with having fun," he said. "That's part of how it works."

He's prepared for a full repertoire of traditional children's songs, but he has also worked with young kids who love The Beatles. And some teens would rather hear music from their earlier childhood than Justin Bieber.

The phone that pages him, though, doesn't beep or ring to alert him to his next destination.

It vibrates, so as to not interrupt the music.

Definition List:
  • oncology: the scientific study of and treatment of tumors (cancer) in the body
  • maracas: a pair of simple musical instruments consisting of hollow balls containing beads or beans that are shaken to produce a sound
  • melodic: connected with the main tune in a piece of music
  • prominent: important or well known
  • neuroscience: the science that deals with the structure and function of the brain and the nervous system
  • nonthreatening: not likely to frighten anyone; not threatening
  • autism: a mental condition in which a person finds it very difficult to communicate or form relationships with others
  • motivator: something that makes somebody want to do something, especially something that involves hard work and effort
  • superb: excellent; of very good quality
  • impairment: the state of having a physical or mental condition which means that part of your body or brain does not work correctly
  • hyped up: very worried or excited about something that is going to happen
  • vigorous: very active, determined or full of energy
  • agoraphobia: a fear of being in public places where there are many other people
  • improvisation: to invent music, the words in a play, a statement, etc. while you are playing or speaking, instead of planning it in advance
  • to drive: to influence something or cause it to make progress
  • to reintegrate: to become or make somebody become accepted as a member of a social group again
  • cohesion: the act or state of keeping together
  • to evict: to force somebody to leave a house or land, especially when you have the legal right to do so
  • PTSD: Posttraumatic stress disorder is a severe condition that may develop after a person is exposed to one or more traumatic events, such as sexual assault, serious injury or the threat of death.
  • to jam: to play music with other musicians in an informal way without preparing or practising first
  • to cope: to deal successfully with something difficult
  • cathartic: the process of releasing strong feelings, for example through plays or other artistic activities, as a way of providing relief from anger, suffering, etc.
  • biofeedback: the use of electronic equipment to record and display activity in the body that is not usually under your conscious control, for example your heart rate, so that you can learn to control that activity
  • cognitive: connected with mental processes of understanding
  • to envision: to imagine what a situation will be like in the future, especially a situation you intend to work towards
  • adverse: negative and unpleasant; not likely to produce a good result
  • intrinsic: belonging to or part of the real nature of something/somebody
  • to poke: to quickly push your fingers or another object (like a needle) into somebody/something
  • to prod: to push somebody/something with your finger or with a pointed object
  • repertoire: all the plays, songs, pieces of music, etc. that a performer knows and can perform
Pronunciation MP3s:
= oncology
= maracas
= melodic
= prominent
= neuroscience
= dopamine
= methamphetamine
= autism
= motivator
= superb
= impairment
= hype
= vigorous
= agoraphobia
= improvisation
= reintegrate
= cohesion
= evict
= jam
= cope
= cathartic
= biofeedback
= cognitive
= envision
= adverse
= intrinsic
= poke
= repertoire